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Should Ovaries Be Conserved at Hysterectomy?

Nurses’ Health Study data showed shortened life expectancy after bilateral oophorectomy.

More than half of U.S. women who undergo hysterectomies at 40 or older also undergo concomitant bilateral oophorectomies (BLOs). To evaluate the health consequences of BLO at hysterectomy, investigators focused on 29,000 Nurses’ Health Study participants who had undergone hysterectomies for benign disease (56% with BLO; the others with ovarian conservation).

At 24-year follow-up, incidences of breast and ovarian cancers were lower in women who underwent BLO than in those who did not (34 and 40 fewer cases per 100,000 woman-years, respectively). However, incidence of coronary heart disease (CHD) was higher with BLO (44 additional cases). Deaths from all causes occurred more frequently after BLO (121 additional deaths per 100,000 woman-years), largely because of elevated risks for deaths from all forms of cancer and from CHD. Among women who underwent hysterectomies before age 50 and who did not use estrogen therapy, survival benefits associated with ovarian conservation were particularly prominent. In this population, BLO was associated with 176 and 140 additional cases of CHD and stroke, respectively, and 329 excess deaths per 100,000 woman-years.

Comment: This publication adds to a substantial literature (JW Womens Health Feb 19 2009) indicating that ovarian steroids play a positive role in the overall health of women as they age. Estrogen deprivation associated with BLO contributes to vascular disease, whereas estrogen therapy in menopausal women in their 50s helps to prevent vascular disease (JW Womens Health Jun 21 2007). BLO at hysterectomy seems ill-advised at any age except in women with specific indications (e.g., BRCA mutation, endometriosis). For women younger than 50 who have lost ovarian function as a result of surgery or for other reasons, hormone therapy is appropriate unless specific contraindications apply.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health May 7, 2009

Citation(s):

Parker WH et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstet Gynecol 2009 May; 113:1027.

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• Should Ovaries be conserved?
  Dominique BAUER-VINASSAC, PARIS FRANCE, 2 Jul 2009 12:49 PM EST
  This should help to reconsider HRT for post menopausal women as a whole and incite american women to seek for... [more]